Methods for treating interleukin-6 related diseases

ABSTRACT

A pharmaceutical composition for the treatment of interleukin-6 (IL-6) related diseases, comprising an interleukin-6 antagonist (IL-6 antagonist) and immunosuppressants. The IL-6 antagonist is preferably an antibody to an interleukin-6 receptor (IL-6R).

BACKGROUND OF INVENTION

1. Field of the Invention

The present invention relates to methods for the treatment ofinterleukin-6 (IL-6) related diseases by the combination of aninterleukin-6 antagonist (IL-6 antagonist), particularly an antibodyagainst interleukin-6 receptor (IL-6R) (anti-IL-6R antibody) withimmunosuppressants and by administering the anti-IL-6R antibody at ahigh dose.

2. Related Art

IL-6 is a cytokine also termed B cell stimulating factor-2 (BSF2) orinterferon β2. IL-6 was discovered as a differentiation factor involvedin activation of B lymphocyte lineage cells (Hirano, T. et al., Nature,324:73-76, 1986), and after then it has been demonstrated that IL-6 isthe multifunctional cytokine which affects functions of various cells(Akira, S. et al., Adv. in Immunology, 54:1-78, 1993). It has beenreported that IL-6 induces maturation of T lymphocyte lineage cells(Lotz, M. et al., J. Exp. Med., 167:1253-1258, 1988).

IL-6 transmits its biological activity via two types of protein oncells. One is IL-6 receptor which is a ligand binding protein withmolecular weight of about 80 kD, to which IL-6 binds (Taga, T. et al.,J. Exp. Med., 166:967-981, 1987; Yamasaki, K. et al., Science,241:825-828, 1987). IL-6 receptor also occurs as soluble IL-6 receptormainly composed of its extracellular region, in addition to a membranebinding type which penetrates through cell membrane and expresses on thecell membrane.

International publication WO 92/19759 describes various types ofanti-IL-6R antibodies such as humanized anti-IL-6R antibodies andchimeric anti-IL-6R antibodies. WO 96/11020 describes the therapeuticagent for rheumatoid arthritis and the inhibitor of synovial cell growthof which primary ingredient is IL-6 antagonist such as anti-IL-6Rantibody. WO 96/12503 describes the treatment of diseases attributed toIL-6 production, such as plasmacytosis, hyperimmunoglobulinemia, anemia,nephritis, cachexia, rheumatoid arthritis, Castleman's disease, andmesangial proliferative nephritis. WO 98/42377 describesprotective/therapeutic agents of sensitized T cell related diseases suchas multiple sclerosis, uveitis, chronic thyroiditis, delayedhypersensitivity, contact dermatitis and atopic dermatitis, of whichactive ingredient is anti-IL-6R antibody.

WO98/42377 describes the therapeutic agents of systemic erythematosus,of which active ingredient is anti-IL-6R antibody. WO99/47170 describesthe therapeutic agents of Crohn's disease, of which active ingredient isanti-IL-6R antibody. WO00/10607 describes the therapeutic agents ofpancreatitis, of which active ingredient is anti-IL-6R antibody.WO02/3492 describes the therapeutic agents of psoriasis, of which activeingredient is anti-IL-6R antibody. Additionally, WO02/080969 describesthe therapeutic agents of juvenile idiopathic arthritis, of which activeingredient is anti-IL-6R antibody.

SUMMARY OF INVENTION

As described above, various preventive or therapeutic agents of whichactive ingredient is anti-IL-6R antibody have been known. However, ithas not been known that synergistic effects can be obtained by thecombination of anti-IL-6R antibody with immunosuppressants such asmethotrexate (MTX) in the treatment of IL-6 related diseases, theimmunosuppressant such as methotrexate (MTX) can reduce or preventallergic reactions upon the treatment of rheumatoid arthritis withanti-IL-6R antibody, and that anti-IL-6R antibody at a high dose canreduce or prevent allergic reactions upon the treatment of rheumatoidarthritis with anti-IL-6R antibody.

Therefore, the present invention provides a pharmaceutical compositionfor the treatment of IL-6 related disease, comprising an interleukin-6antagonist (IL-6 antagonist) and immunosuppressants.

The invention also provides a pharmaceutical composition comprisingimmunosuppressants, for the effect enhancement on the use of an IL-6antagonist for the treatment of IL-6 related disease.

The invention also provides a pharmaceutical composition comprisingimmunosuppressants, for the prevention or reduction of allergicreactions upon the treatment of IL-6 related diseases with the IL-6antagonist.

The invention further provides a therapeutic agent for IL-6 relateddiseases to administer at a high dose, comprising an IL-6 antagonist.

The invention further provides a pharmaceutical composition comprisingan IL-6 antagonist at a high dose, for the prevention or reduction ofallergic reactions upon the treatment of IL-6 related diseases.

The IL-6 antagonist is preferably an anti-IL-6R antibody. The anti-IL-6Rantibody is preferably a monoclonal antibody against IL-6R. Preferably,the anti-IL-6R antibody is the monoclonal antibody against human IL-6R.Or, preferably, the anti-IL-6R antibody is the monoclonal antibodyagainst mouse IL-6R. Preferably, the anti-IL-6R antibody is arecombinant type antibody. Preferably, the human anti-IL-6R monoclonalantibody is, for example, PM-1 antibody. Preferably, the mouseanti-IL-6R monoclonal antibody is, for example, MR16-1 antibody. Theantibody may be further a chimeric antibody, a humanized antibody or ahuman antibody against IL-6R. Specific preferable anti-IL-6R antibodyis, for example, humanized PM-1 antibody.

When combining the IL-6 antagonist, particularly the anti-IL-6R antibodywith the immunosuppressant, the dosage of the IL-6 antagonist,particularly the anti-IL-6R antibody is, for example, in the case ofintravenous infusion, from 0.02 to 150 mg/kg/4 weeks or the dosageshowing an anti-IL-6R antibody concentration in blood equivalentthereto, preferably from 0.5 to 30 mg/kg/4 weeks or the dosage showingthe anti-IL-6R antibody concentration in blood equivalent thereto, andmore preferably from 2 to 8 mg/kg/4 weeks or the dosage showing theanti-IL-6R antibody concentration in blood equivalent thereto.

When administering the IL-6 antagonist, particularly the anti-IL-6Rantibody at a high dose, the dosage of the IL-6 antagonist, particularlythe anti-IL-6R antibody is, for example, in the case of intravenousinfusion, not less than 4 mg/kg/4 weeks or the dosage showing theanti-IL-6R antibody concentration in blood equivalent thereto,preferably from 6 to 16 mg/kg/4 weeks or the dosage showing ananti-IL-6R antibody concentration in blood equivalent thereto, and morepreferably from 6 to 10 mg/kg/4 weeks or the dosage showing theanti-IL-6R antibody concentration in blood equivalent thereto.

When MTX is used as the immunosuppressant, the dosage of MTX is, forexample, from 1 to 100 mg/body/weeks or the dosage showing the MTXconcentration in blood equivalent thereto, preferably from 4 to 50mg/body/week or the dosage showing the MTX concentration in bloodequivalent thereto, and particularly preferably from 10 to 25mg/body/weeks or the dosage showing the MTX concentration in bloodequivalent thereto.

The dosage showing the drug (e.g., anti-IL-6R antibody MTX)concentration in blood means a dosage giving an equivalent therapeuticeffect, and even when the transition of the concentration in bloodvaries according to the administration method such as intravenousinjection and subcutaneous injection, it is regarded as the dosageshowing the drug (e.g., anti-IL-6R antibody or MTX) concentration inblood so long as the therapeutic effect is equivalent.

Examples of the IL-6 related diseases include,

Acute chronic inflammatory diseases and autoimmune diseases: nephritis,mesangial proliferative nephritis, Crohn's disease, ulcerative colitis,pancreatitis, juvenile idiopathic arthritis or systemic juvenileidiopathic arthritis, vasculitis, Kawasaki disease, rheumatoidarthritis, systemic erythematosus, psoriasis, Sjogren syndrome, adultStill's disease;

neoplasmic diseases: multiple myeloma, Castleman's disease, malignantlymphoma, renal cancer;

infectious diseases: infection with HIV, infection with EBV;

cachexia: cachexia

others: plasmacytosis, hyperimmunoglobulinemia, anemia and so on, andare preferably rheumatoid arthritis, plasmacytosis,hyperimmunoglobulinemia, anemia, nephritis, cachexia, multiple myeloma,Castleman's disease, mesangial proliferative nephritis, systemicerythematosus, Crohn's disease, pancreatitis, psoriasis, juvenileidiopathic arthritis or systemic juvenile idiopathic arthritis.

The pharmaceutical composition of the invention can be administeredorally or parenterally and systemically or topically. For instance,intravenous injection such as drip infusion, intramuscular injection,intraperitoneal injection, subcutaneous injection, suppository, colonicinjection, oral enteric coating drug and the like can be selected, andthe administration method can be appropriately selected depending on aage and condition of a patient. The upper and lower limits of the actualdosage are affected by the frequency of administration, for example, thedosage per dose increases in the case of long administration intervalwhereas it decreases in the case of short administration interval.

For the preferable dosage and administration method of the anti-IL-6receptor antibody, for instance, the amount at an extent as the freeantibody exists in blood is the effective dosage. As specific examples,there are methods to administer dividing one to several times, forexample, according to an administration schedule of twice/week,once/week, once/two weeks, once/4 weeks, once/6 weeks, once/8 weeks andthe like by the method of intravenous injection such as drip infusionand subcutaneous injection. The administration schedule can be adjustedsuch as extending the administration interval from twice/week oronce/week to once/2 weeks, once/3 weeks, once/4 weeks, once/6 weeks andonce/8 weeks with observing the disease condition and changes oflaboratory data in blood.

When administered in combination with MTX, the dosage of the anti-IL-6Rantibody is typically, for example, in the case of the rheumatoidarthritis treatment, the dosage more than 0.5 mg/kg per week or thedosage showing an equivalent or more anti-rheumatic effect. Forinstance, when the intravenous administration is carried out once fourweeks, the dosage is from 0.02 to 150 mg/kg, preferably from 0.5 to 30mg/kg, and more preferably from 2 to 8 mg/kg.

The anti-IL-6R antibody and the immunosuppressant are administeredsimultaneously or with a time interval.

The immunosuppressants also encompass anti-rheumatic agents,adrenocortical hormone agents and the like, and include, for example,the following drugs.

A. Immunosuppressants, Anti-Rheumatic Agents, Adrenocortical HormoneAgents

Immunosuppressants

Alkylating agents

-   -   Cyclophosphamide

Metabolic antagonists

-   -   Azathioprine, methotrexate, mizoribine

T cell activity inhibitors

-   -   Cyclosporine, tacrolimus        Anti-Rheumatic Agents:

Hydroxychloroquine, sulfasalazine, leflunomide, etanercept, infliximab,adalimumab, D-penicillamine, oral gold compound, injectable goldcompound (intramuscular injection), minocycline, sodium gold thiomalate,auranofin, D-penicillamine, lobenzarit, bucillamine, actarit;

Adrenocortical Hormone Agents:

Cortisone, hydrocortisones

-   -   Cortisone acetate, hydrocortisone, hydrocortisone sodium        phosphate, hydrocortisone sodium succinate, fludrocortisone        acetate

Prednisolone, prednisolones

-   -   Prednisolone, prednisolone sodium succinate, prednisolone sodium        phosphate, halopredone acetate

Methyl prednisolones

-   -   Methyl prednisolone, methyl prednisolone acetate, methyl        prednisolone sodium succinate

Triamcinolones

-   -   Triamcinolone, triamcinolone acetate, triamcinolone actinide

Dexamethasones

-   -   Dexamethasone, dexamethasone acetate, dexamethasone sodium        phosphate, dexamethasone palmitate

Betamethasones

-   -   Betamethasone (betamethasone sodium phosphate), betamethasone,        betamethasone sodium phosphate

Paramethasones

-   -   Paramethasone acetate

The dosage of the immunosuppressant is, for example when MTX is combinedfor the rheumatoid arthritis treatment, for example in the case oforally administering, from 1 to 100 mg/body per week, preferably from 4to 50 mg, and more preferably from 7.5 to 25 mg/body.

Also, a high dosage of the anti-IL-6R antibody means the dosage capableof preventing or reducing the allergic reaction, which is equal to ormore than a minimum dosage effective for the treatment of IL-6 relateddiseases. For instance, in the rheumatoid arthritis treatment, whenintravenous drip fusion is administered every four weeks, the dosageincludes 4 mg/kg or more, preferably from 6 to 16 mg/kg, and morepreferably from 6 to 10 mg/kg.

The above administration method, interval, and dosage areexemplifications of preferable examples, and the administration method,interval, and dosage which show similar therapeutic effects can beappropriately selected. For instance, it is possible to select theadministration method, interval, and dosage which show the similareffects to those of the above preferable examples by measuring theconcentrations of various medicines in blood. The invention includes theadministration method, interval, and dosage which achieve the equivalentconcentrations in blood to those of the above examples.

MODE FOR CARRYING OUT THE INVENTION

The IL-6 antagonist used in the invention may be used without regard toits origin, type and form as long as it exhibits the preventive ortherapeutic effect on IL-6 related diseases.

The IL-6 antagonists are substances which inhibit biological activity ofIL-6. The IL-6 antagonists are preferably the substances having aninhibitory effect on the binding to either IL-6, IL-6R or gp130. TheIL-6 antagonists include anti-IL-6 antibody, anti-IL-6R antibody,anti-gp130 antibody, modified IL-6, modified soluble IL-6R, or partialpeptides of IL-6 or IL-6R, as well as low molecular substances whichexhibit the similar activity thereto.

The anti-IL-6 antibody used in the invention can be obtained aspolyclonal or monoclonal antibody using means known in the art. As theanti-IL-6 antibody used in the invention, the monoclonal antibodyderived from mammalian animals is preferable. The monoclonal antibodiesderived from mammalian animals include those in produced hybridomas, andthose produced in host cells transformed with expression vectorcontaining the antibody gene by gene engineering technique. Thisantibody inhibits the binding of IL-6 to IL-6 receptor by binding toIL-6 to block signaling of IL-6 biological activity into cells.

Such antibodies include MH166 (Matsuda, T. et al., Eur. J. Immunol.,18:951-956, 1988) and SK2 (Sato, K. et al., The 21st Proceedings of theJapanese Society for Immunology, 21:166, 1991).

Hybridomas producing the anti-IL-6 antibody can be made basically usingthe technology known in the art as follows. That is, the hybridomas canbe made by performing immunization using IL-6 as a sensitized antigenaccording to the standard immunization method, fusing the resultantimmunized cells to parent cells known in the art by the standard cellfusion method, and screening cells producing the monoclonal antibody bythe standard screening method.

Specifically, the anti-IL-6 antibody can be made as follows. Forinstance, human IL-6 used as the sensitized antigen to obtain theantibody can be obtained using the genel amino acid sequence of IL-6disclosed in Eur. J. Biochem., 168:543-550, 1987; J. Immunol.,140:1534-1541, 1988; or Agr. Biol. Chem., 54:2685-2688, 1990.

The gene sequence of IL-6 is inserted into the expression vector knownin the art, which transforms appropriate host cells, subsequently, thetarget IL-6 protein is purified from the cells or the culturesupernatant by the method known in the art, and the purified IL-6protein can be used as the sensitized antigen. Also, the fusion proteinof the IL-6 protein with the other protein may be used as the sensitizedantigen.

The anti-IL-6 receptor antibody used in the invention can be obtained aspolyclonal or monoclonal antibody using means known in the art. As theanti-IL-6 receptor antibody used in the invention, the monoclonalantibody derived from mammalian animals is preferable. The monoclonalantibodies derived from mammalian animals include those in producedhybridomas, and those produced in host cells transformed with expressionvector containing the antibody gene by gene engineering technique. Thisantibody inhibits the binding of IL-6 to IL-6 receptor by binding toIL-6 receptor to block signaling of IL-6 biological activity into cells.

Such antibodies include MR16-1 antibody (Tamura, T. et al., Proc. Natl.Acad. Sci. USA, 90:11924-11928, 1993), PM-1 antibody (Hirata, Y. et al.,J. Immunol., 143:2900-2906, 1989), AUK-12-20 antibody, AUK64-7 antibodyor AUK146-15 antibody (International Patent Application Publication No.WO 92-19759). Among them, the particularly preferable antibody includesPM-1 antibody.

The hybridoma cell line producing PM-1 antibody as PM-1 has beeninternationally deposited at International Patent Organism Depository(AIST Tsukuba Central 6, 1-1, Higashi 1-chome, Tsukuba-shi, IbarakiPref.) on the basis of Budapest Treaty as FERM BP-2998 on Jul. 12, 1989.The hybridoma cell line producing MR16-1 antibody as rat-mouse hybridomaMR16-1 has been internationally deposited at International PatentOrganism Depository (AIST Tsukuba Central 6, 1-1, Higashi 1-chome,Tsukuba-shi, Ibaraki Pref.) on the basis of Budapest Treaty as FERMBP-5875 on Mar. 13, 1997.

Hybridomas producing the anti-IL-6 receptor monoclonal antibody can bemade basically using the technology known in the art as follows. Thatis, the hybridomas can be made by performing immunization using IL-6receptor as a sensitized antigen according to the standard immunizationmethod, fusing the resultant immunized cells to parent cells known inthe art by the standard cell fusion method, and screening cellsproducing the monoclonal antibody by the standard screening method.

Specifically, the anti-IL-6 receptor antibody can be made as follows.For instance, human IL-6 receptors used as the sensitized antibody toobtain the antibody can be obtained by using IL-6 receptor gene/aminoacid sequences disclosed in European Patent Application Publication No.EP325474 and JP-A-3-155795, respectively.

The IL-6 receptor protein has two types, i.e., one expressed on cellsand one dissociated from the cell membrane (soluble IL-6receptor)(Yasukawa, K. et al., J. Biochem., 108:673-676). The solubleIL-6 receptor is substantially composed of an extracellular region ofthe IL-6 receptor, and is different from the membrane binding IL-6receptor in lacking a transmembrane region or transmembrane andintracellular regions. Both IL-6 receptor proteins may be used as longas they are used as the sensitized antigen for the production of theanti-IL-6 receptor antibody used in the invention.

The gene sequence of IL-6 receptor is inserted into the expressionvector known in the art, which transforms appropriate host cells,subsequently, the target IL-6 receptor protein is purified from thecells or the culture supernatant by the method known in the art, and thepurified IL-6 receptor protein can be used as the sensitized antigen.Also, the cells expressing IL-6 receptor and the fusion protein of theIL-6 receptor protein with the other protein may be used as thesensitized antigen.

E. coli containing plasmid, pIBIBSF2R including cDNA encoding human IL-6receptor as HB101-pIBIBSF2R has been internationally deposited atInternational Patent organism Depository (AIST Tsukuba Central 6, 1-1,Higashi 1-chome, Tsukuba-shi, Ibaraki Pref.) on the basis of BudapestTreaty as the access No. FERM BP-2232 as of Jan. 9, 1989.

The anti-gp130 antibody used in the invention can be obtained aspolyclonal or monoclonal antibody using means known in the art. As theanti-gp130 antibody used in the invention, the monoclonal antibodyderived from mammalian animals is preferable. The monoclonal antibodiesderived from mammalian animals include those in produced hybridomas, andthose produced in host cells transformed with expression vectorcontaining the antibody gene by gene engineering technique. Thisantibody inhibits the binding of IL-6/IL-6 receptor complex to gp130 bybinding to gp130 to block signaling of IL-6 biological activity intocells.

Such antibodies include AM64 antibody (JP-A-3-219894), 4B11 antibody and2H4 antibody (U.S. Pat. No. 5,571,513), B-S12 antibody and B-P8 antibody(JP-A-8-291199).

Hybridomas producing the anti-gp130 monoclonal antibody can be madebasically using the technology known in the art as follows. That is, thehybridomas can be made by performing immunization using gp130 as asensitized antigen according to the standard immunization method, fusingthe resultant immunized cells to parent cells known in the art by thestandard cell fusion method, and screening cells producing themonoclonal antibody by the standard screening method.

Specifically, the monoclonal antibody can be made as follows. Forinstance, gp130 used as the sensitized antigen to obtain the antibodycan be obtained by using the gp130 gene/amino acid sequences disclosedin European Patent Application Publication No. EP 411946.

The gene sequence of gp130 is inserted into the expression vector systemknown in the art, which transforms appropriate host cells, subsequently,the target gp130 protein is purified from the cells or the culturesupernatant by the method known in the art, and the purified gp130protein can be used as the sensitized antigen. Also, the cellsexpressing gp130 and the fusion protein of the gp130 protein with theother protein may be used as the sensitized antigen.

Mammalian animals immunized with the sensitized antigen are notparticularly limited, but preferably selected in consideration ofcompatibility with parent cells used for cell fusion. In general, rodentanimals such as mouse, rat and hamster are used.

Immunization of the animal with the sensitized antigen is carried outaccording to the methods known in the art. As the general methods, it iscarried out by injecting the sensitized antigen to the animalintraperitoneally or subcutaneously. Specifically, it is preferred thatthe sensitized antigen is appropriately diluted and suspended with PBS(phosphate-buffered saline) or saline, which is mixed with anappropriate amount of standard adjuvant, e.g., Freund's completeadjuvant to be emulsified, and subsequently administered to themammalian animal several times with an interval of 4 to 21 days. Also,an appropriate carrier can be used upon the immunization with thesensitized antigen.

The animal is immunized in this way and it is confirmed that levels ofthe desired antibody are increased in serum. Subsequently, the immunizedcells are removed from the mammalian animal, and are committed for cellfusion. Preferable immunized cells committed for cell fusionparticularly include spleen cells.

For myeloma cells of the mammalian animals as partner parent cells fusedwith the above immunized cells, cell lines already known in the art,e.g., P3X63Ag8.653 (Kearney, J. F. et al., J. Immunol., 123:1548-1550,1979), P3X63Ag8U.1 (Current Topics in Microbiology and Immunology,81:1-7, 1978), NS-1 (Kohler, G. and Milstein, C., Eur. J. Immunol.,6:511-519, 1976), MOC-11 (Margulies D. H. et al., Cell, 8:405-415,1976), SP2/0 (Shulman, M. et al., Nature, 276:269-270, 1978), FO (de St.Groth, S. F. et al., J. Immunol, Methods, 35:1-21, 1980), S194(Trowbridge, I. S. J. Exp. Med., 148:311-323, 1978), R210 (Galfre, G. etal., Nature, 277:131-133, 1979) are appropriately used.

The cell fusion of the above immunized cells with myeloma cells can becarried out basically according to the methods known in the art, e.g.,Milstein's method (Kohler G. and Milstein C., Methods Enzymol., 73:3-46,1981).

More specifically, the above cell fusion is performed, for example, inthe standard nutrient culture medium in the presence of a cell fusionaccelerator. As the cell fusion accelerator, for example,polyethyleneglycol (PEG), Sendai virus (HVJ) and the like are used, andan auxiliary agent such as dimethylsulfoxide can be further added/usedas desired in order to increase the fusion efficiency.

A use ratio of the immunized cells to the myeloma cells is preferably,for example, 1 to 10 folds of the immunized cells to the myeloma cells.As media used for the above cell fusion, the use of RPMI 1640 medium,MEM medium suitable for growth of the myeloma cell line, and the otherstandard media used for this type of cell culture is possible, andfurther serum supplement such as feral calf serum (FCS) can be combined.

For the cell fusion, the target fused cells (hybridomas) are formed bythoroughly mixing the above immunized cells with the myeloma cells atthe given amounts in the above medium, adding PEG solution, e.g., PEGsolution with average molecular weight of about 1000 to 6000 prewarmedat 37° C. at a standard concentration of 30 to 60% (w/v), and mixing.Subsequently, a cell fusion agent and the like which are not preferablefor the growth of the hybridomas can be removed by repeating themanipulation of sequentially adding the appropriate medium and removingthe supernatant by centrifuge.

The hybridomas are selected by culturing in the standard selectionmedium, e.g., HAT medium (medium containing hypoxanthine, aminopterinand thymidine). The culture in the HAT medium is continued for typicallyfrom several day to several weeks, sufficient time period until cellsother than the target hybridomas (non-fused cells) die out. Then, thestandard limiting dilution method is performed, and the hybridomasproducing the target antibody are screened and cloned.

Also in addition to obtaining the above hybridoma by immunizing theanimal other than human with the antigen, desired human antibody havingbinding activity to the desired antigen or cells expressing the antigencan be obtained by sensitizing human lymphocytes with the antigenprotein or the cells expressing the antigen in vitro, and fusing thesensitized B lymphocytes with human myeloma cells, e.g., U266 (seeJP-B-1-59878). Moreover, the antigen or antigen expressing cells may beadministered to transgenic animals having repertoire of human antibodygene to obtain the desired human antibody according to the methoddescribed above (See International Patent Application Publication Nos.WO 93/12227, WO 92/03918, WO 94/02602, WO 94/25585, WO 96/34096, WO96/33735).

The hybridoma producing the monoclonal antibody made in this way can becultured in the standard culture medium, and also can be stored inliquid nitrogen for a long time.

In order to obtain the monoclonal antibody from the hybridomas, employedis the method where the hybridomas are cultured according to thestandard method and the monoclonal antibody is obtained as its culturesupernatant, or the method where the hybridomas are propagated byadministering to the compatible mammalian animal therewith and themonoclonal antibody is obtained as its ascites. The former method issuitable for obtaining the antibody with a high purity, and the lattermethod is suitable for producing the antibody at a large scale.

For instance, the production of the hybridoma producing the anti-IL-6receptor antibody can be carried out by the method disclosed inJP-A-3-139293. The method where hybridomas producing PM-1 antibodyinternationally deposited at International Patent Organism Depository(AIST Tsukuba Central 6, 1-1, Higashi 1-chome, Tsukuba-shi, IbarakiPref.) as FERM BP-2998 on Jul. 12, 1989 on the basis of Budapest Treatyare injected intraperitoneally to BALB/c mouse to obtain the ascites andPM-1 antibody is purified from this ascites can be carried out. Also,the method where the present hybridomas are cultured in the appropriatemedium, for example, RPMI 1640 medium, hybridoma SFM medium (suppliedfrom GIBCO-BRL), PFHM-II medium (supplied from GIBCO-BRL) containing 10%fetal calf serum and 5% BM-Condimed H1 (supplied from BoehringerMannheim) and PM-1 antibody is purified from its culture supernatant canbe carried out.

In the invention, as the monoclonal antibody, it is possible to userecombinant type antibody produced by cloning the antibody gene from thehybridoma, inserting the gene into an appropriate vector, introducingthis into host cells, and using gene engineering technology (see, forexample, Borrebaeck, C. A. K. and Larrick, J. M., Therapeutic MonoclonalAntibodies, published in the United Kingdom by Macmillan PublishersLtd., 1990).

Specifically, mRNA encoding the variable (V) region of the antibody isisolated from the cells producing the target antibody, e.g., hybridomas.For the isolation of mRNA, total RNA is prepared by the methods known inthe art, e.g., guanidine ultracentrifuge method (Chirgwin, J. M. et al.,Biochemistry, 18:5294-5299, 1979), AGPC method (Chomczynski, P. et al.,Anal. Biochem., 162:156-159, 1987), and mRNA is prepared by the use ofmRNA Purification Kit (supplied from Pharmacia). Also, mRNA can bedirectly prepared by the use of QuickPrep mRNA Purification Kit(supplied from Pharmacia).

cDNA of the antibody V region is synthesized from the resultant mRNAusing reverse transcriptase. The synthesis of cDNA can be carried outusing AMV Reverse Transcriptase First-strand cDNA Synthesis Kit and thelike. Also, 5′-Ampli FINDER RACE kit (supplied from Clontech) and5′-RACE method using PCR (Frohman, M. A. et al., Proc. Natl. Acad. Sci.USA, 85:8998-9002, 1988; Belyavsky A. et al., Nucleic Acids Res.,17:2919-2932, 1989) can be used to synthesize and amplify cDNA. Thetarget DNA fragment is purified from the resultant PCR product, andligated to the vector DNA. Further, a recombinant vector is made bythis, which is introduced into E. coli, and colonies are selected toprepare the desired recombinant vector. The base sequence of the targetDNA is confirmed by the method known in the art, e.g., deoxy method.

If the DNA encoding the V region of the target antibody is obtained,this is ligated to DNA encoding the constant (C region) region of thedesired antibody, and then it is incorporated into the expressionvector. Or the DNA encoding the V region of the antibody may beincorporated into the expression vector containing the C region of theantibody.

In order to produce the antibody used in the invention, the antibodygene is incorporated into the expression vector so as to express underthe expression regulation regions such as enhancer and promoter asdescribed later. Next, host cells can be transformed with thisexpression vector to express the antibody.

In the invention, artificially modified gene recombinant antibodies,e.g., chimeric antibody, humanized antibody and human antibody can beused for the purpose of reducing allogenic antigenicity for human. Thesemodified antibodies can be made using the known methods.

The chimeric antibody can be obtained by ligating the DNA encoding theantibody V region obtained as above to the DNA encoding the humanantibody C region and incorporating this into expression vector to beintroduced to host to produce (see European Patent ApplicationPublication NO. EP 125023, International Patent Application PublicationNo. WO 92/19759). Using these known methods, the chimeric antibodyuseful for the invention can be obtained.

For example, the plasmids containing DNA encoding the V regions of the Land H chains of the PM-1 chimeric antibody were named pPM-k3 and pPM-h1,respectively, and E. coli having these plasmids have beeninternationally deposited at National Collections of Industrial, Foodand Marine Bacteria Limited (23 St. Machar Drive, Aberdeen AB2 1RY,Scotland, United Kingdom) as NCIMB 40366 and NCIMB 40362, respectivelyon Feb. 12, 1991 on the basis of Budapest Treaty.

The humanized antibodies are also referred to as reshaped humanantibodies, are those in which the complementarity determining region(CDR) of the antibody of the mammalian animal other than human, e.g.,mouse is transplanted in the complementarity determining region-of thehuman antibody, and its general gene recombinant method has been known(see European Patent Application Publication NO. EP 125023,International Patent Application Publication No. WO 92/19759).

Specifically, the DNA sequence designed to link the CDR of the mouseantibody to the framework region (FR) of the human antibody issynthesized by PCR from several oligonucleotides made to have anoverlapping portion at the terminus. The resultant DNA is ligated to theDNA encoding the human antibody C region, then it is incorporated intothe expression vector, which is introduced into the host to produce thehumanized antibody (see European Patent Application Publication NO. EP239400, International Patent Application Publication No. WO 92/19759).

As FR of the human antibody ligated via the CDR, those are selectedwhere the complementarity determining region forms a good antigenbinding site. Amino acids in the framework region of the antibodyvariable region may be substituted as needed such that thecomplementarity determining region of the reshaped human antibody formsthe proper antigen binding site (Sato, K. et al., Cancer Res.,53:851-856, 1993).

The human antibody C region is used for the chimeric antibody andhumanized antibody. The human antibody C region includes Cγ, and forexample, Cγ1, Cγ2, Cγ3 or Cγ4 can be used. The human antibody C regionmay be modified to improve stability of the antibody or the productionthereof.

The chimeric antibody is composed of the variable region of the antibodyderived from the mammalian animal other than human and the C regionderived from the human antibody. The humanized antibody is composed ofthe complementarity determining region the antibody derived from themammalian animal other than human and the framework region and the Cregion derived from the human antibody. Therefore, these have reducedantigenicity in the human body and thus are useful as the antibody usedin the invention.

Preferable specific examples of the humanized antibody used in theinvention include humanized PM-1 antibody (see International PatentApplication Publication No. WO 92-19759).

Also, as the methods to obtain the human antibody, the technology toobtain the human antibody by panning using human antibody library isknown in addition to the methods described above. For example, thevariable region of the human antibody can be expressed on the surface ofphages as a single strand antibody (scFv) by the phage display method,and the phages bound to the antigen can be selected. When the gene ofthe selected phages is analyzed, the DNA sequence encoding the variableregion of the human antibody bound to the antigen can be determined. Ifthe DNA sequence of scFv bound to the antigen is demonstrated, thesequence can be made by an appropriate expression vector to obtain thehuman antibody. These methods have been already well-known, and it ispossible to cite WO 92101047, WO 92/20791, WO 93/06213, WO 93/11236, WO93/19172, WO 95/01438, and WO 95/15388.

The antibody gene constructed as described above can be expressed andobtained by the methods known in the art. In the case of the mammaliancells, the antibody gene can be expressed by the DNA in which commonlyuseful promoter, the antibody gene to be expressed, and poly A signal 3′downstream therefrom are functionally bound, or by the vector containingthem. For instance, promoter/enhancer can include human cytomegalovirusimmediate early promoter/enhancer.

Also, as the other promoter/enhancer capable of being used for theexpression of the antibody used in the invention, the viralpromoter/enhancer of retrovirus, polyoma virus, adenovirus, simian virus40(SV40), and the promoter/enhancer derived from the mammalian cellshuman elongation factor 1α (HEF1α) can be used.

For instance, the expression can be performed according to Mulligan etal's method (Mulligan, R. C. et al., Nature, 277:108-114, 1979) in thecase of using SV40 promoter/enhancer, or Mizushima et al's method(Mizushima, S and Nagata, S., Nucleic Acids Res., 18:5322, 1990) in thecase of using HEF1α promoter/enhancer.

In the case of E. coli, the gene can be expressed by functionallybinding commonly useful promoter, a signal sequence for antigensecretion and the antibody gene to be expressed. For instance, thepromoters can include lacZ promoter and araB promoter. Ward et al'smethod (Ward, E. S. et al., Nature, 341:544-546, 1989; Ward, E. S. etal., FASEB J., 6:2422-2427, 1992) and Better et al's method (Better, M.et al., Science, 240:1041-1043, 1988) can be used in the cases of usinglacZ promoter and araB promoter, respectively.

As the signal sequence for the secretion of antibody, pelB signalsequence (Lei, S. P. et al., Bacteriol., 169:4379-4383, 1987) can beused in the case of the production in periplasm of E. coli. The antibodyproduced in the periplasm is isolated, and subsequently used byappropriately refolding the antibody structure (see, for example, WO96/30394).

Those derived from SV40, polyoma virus, adenovirus, bovine papillomavirus (BPV) can be used as a replication origin. Additionally, for theamplification of gene copy number in the host cell system, theexpression vector can include aminoglycoside phosphotransferase (APH)gene, thymidine kinase (TK) gene, E. coli xanthine guaninephosphoribosyl transferase (Ecogpt) gene, dihydrofolate reductase (dhfr)gene and the like as selection markers.

For the production of the antibody used in the invention, an optionalproduction system can be used. There are in vitro and in vivo systems ofthe production for making the antibody. The production system in vitroinclude the production system using eukaryotic cells and the productionsystem using prokaryotic cells.

In the cases of using eukaryotic cells, there are the production systemsusing animal cells, plant cells, or fungus cells. As the animal cells,(1) mammalian cells, e.g., CHO, COS, myeloma, BHK (baby hamster kidney),HeLa, Vero, etc., (2) amphibian cells, e.g., oocytes of Xenopus, or (3)insect cells, e.g., sf9, sf21, Tn5, etc. are known. As plant cells, thecell derived from Nicotiana tabacum is known and this can be cultured ascallus. As fungus cells, yeast, for example, genus Saccharomyces, e.g.,Saccharomyces cerevisiae, and Filamentous, for example, genusAspergillus, e.g., Aspergillus niger are known.

In the case of using prokaryotic cells, there are the production systemsusing bacterial cells. As the bacterial cells, E. coli and Bacillussubtilis are known.

The antibody can be obtained by introducing the target antibody geneinto these cells by transformation and culturing the transformed cellsin vitro. The culture is carried out according to the methods known inthe art. For instance, DMEM, MEM, RPMI 1640 and IMDM can be used as themedium, and the serum supplement such as fetal calf serum (FCS) can bealso combined. The antibody may be produced in vivo by transferring thecells in which the antibody gene is introduced into a peritoneal cavityof the animal.

On the other hand, the production systems in vivo include the productionsystems using animals and the production systems using plant cells. Inthe case of using animal cells, there are the production system usingmammalian animals and insects.

As the mammalian animals, a goat, swine, sheep, mouse, cattle and thelike can be used (Vicki Glaser, Spectrum Biotechnology Applications,1993). Also, as insects, a silk worm can be used. In the case of usingplants, for example, tobacco can be used.

The antibody gene is introduced into these animals or plants, theantibody is produced in the body of the animal or plant, and iscollected. For example, the antibody gene is prepared as a fusion geneby inserting in a midstream of the gene encoding the protein inherentlyproduced in milk such as goat β casein. The DNA fragment containing thefusion gene inserted the antibody gene is injected into goat embryo,which is transferred in a female goat. The desired antibody is obtainedfrom the milk of a transgenic goat born from the goat which received theembryo or progenies thereof. Appropriate hormones may be used for thetransgenic goat in order to increase an amount of the milk containingthe desired antibody (Ebert, K. M. et al., Bio/Technology, 12:699-702,1994).

In the case of using silk worms, the silk worms are infected withbaculovirus inserted the target antibody gene, and the desired antibodyis obtained from body fluid of these silk worms (Maeda, S. et al.,Nature, 315:592-594, 1985). Moreover, in the case of using tobacco, thetarget antibody gene is inserted into plant expression vector, e.g.,pMON 530, and this vector is introduced into bacteria such asAgrobacterium tumefaciens. The tobacco, such as Nicotiana tabacum, isinfected with these bacteria, and the desired antibody is obtained fromleaves of this tobacco (Julian, K. C., Ma, et al., Eur. J. Immunol.,24:131-138, 1994).

When the antibody is produced in the production system in vitro or invivo as described above, the DNA encoding the antibody heavy chain (Hchain) or light chain (L chain) may be separately incorporated into theexpression vectors, which may simultaneously transform the host, or theDNA encoding the H chain and L chain are incorporated into a singleexpression vector, which may transform the host (see InternationalPatent Application Publication No. WO 94-11523).

The antibody used in the invention may be fragments of the antibody ormodification thereof as long as the antibody is suitably used. Forinstance, the fragments of the antibody include, for example, Fab,F(ab′)², Fv, or single chain Fv (scFv) where Fv of the H and L chainsare linked by an appropriate linker.

Specifically, the antibody is treated with enzyme, such as papain,pepsin, to generate the antibody fragments, or the gene encoding theantibody fragment is constructed, and this is introduced into theexpression vector, which is expressed in an appropriate host cells (see,for example, Co, M. S. et al., J. Immunol., 152:2968-2976, 1994; Better,M. & Horwitz, A. E., Methods in Enzymology, 178:476-496, 1989;Plueckthun, A. & Skerra, A., methods in Enzymology, 178:476-496, 1989;Lamoyi, E., Methods in Enzymology, 121:652-663, 1989; Rousseaux, J. etal., Methods in Enzymology, 121:663-66, 1989; Bird, R. E. et al.,TIBTECH, 9:132-137, 1991).

By ligating the H chain V region to the L chain V region, scFv isobtained. In this scFv, the H chain V region and the L chain V regionare preferably linked via a linker, preferably a peptide linker (Huston,J. S. et al., Proc. Natl. Acad. Sci. USA, 85:5879-5883, 1988). The Hchain V region and the L chain V region in ScFv may de derived from anyof those described as the above antibody. As the peptide linker whichlinks the V regions, used is, for example, a given single chain peptidecomposed of 12 to 19 amino acid residues.

DNA encoding scFv is obtained by amplifying the DNA portion encoding thedesired amino acid sequence among DNA encoding the H chain or H chain Vregion and L chain or L chain V region of the above antibody, which areused as templates using primers which define the both ends thereof byPCR method, then further by amplifying DNA encoding the peptide linkerportion and the both ends thereof combining a pair of primers whichdefine to be linked to the H and L chains.

Also, once the DNA encoding scFv is made, the expression vectorcontaining them, and the host transformed with the expression vector canbe obtained according to the standard methods, and scFv can be obtainedusing the host according to the standard methods.

For these antibody fragments, their genes can be obtained, expressed andproduced by the hosts as with the above. “Antibody” referred to in theinvention includes these antibody fragments.

As modification of the antibody, it is also possible to use the antibodybound to various molecules such as polyethyleneglycol (PEG). “Antibody”referred to in the invention includes these antibody modification. Inorder to obtain such antibody modifications, they can be obtained bygiving chemical modification to the obtained antibody. These methodshave been already established in this field.

The antibody produced and expressed as the above can be isolated frominside and outside of cells and the host, and purified to be homogenous.The isolation and purification of the antibody used in the invention canbe carried out by affinity chromatography. The column used in theaffinity chromatography includes, for example, protein A column andprotein G column. Carriers used for the protein A column include HyperD, POROS, Sepharose F. F. and the like. The other isolation/purificationmethods used for normal proteins can be used, and the methods are notlimited at all.

For example, the antibody used in the invention can be isolated andpurified by appropriately selecting and combining chromatography otherthan the above affinity chromatography, filter, ultrafiltration, saltingout, dialysis and so on. Examples of chromatography include ion exchangechromatography, hydrophobic chromatography, gel filtration and the like.Such chromatography can be applied for HPLC (high performance liquidchromatography). Also reverse phase HPLC may be used.

Measurement of concentrations of the antibody obtained above can becarried out by the measurement of absorbance or by ELISA. That is, inthe case of the measurement of the absorbance, the antibody isappropriately diluted with PBS(−) followed by measuring the absorbanceat 280 nm, and the concentration is calculated by 1 mg/ml as 1.35 OD. Inthe case by ELISA, the measurement can be carried out as follows. Thatis, 100 μl of goat anti-human IgG (supplied from TAG) diluted at 1 μg/mlwith 0.1 M bicarbonate buffer (pH 9.6) is added to a 96-well plate(supplied from Nunc), and is incubated overnight at 4° C. to immobilizethe antibody. After blocking, 100 μl of the appropriately dilutedantibody used in the invention or a sample containing the antibody, orhuman IgG (supplied from Cappel) as the standard is added, and incubatedat room temperature for one hour.

After washing, 100 μl of alkaline phosphatase labeled anti-human IgG(supplied from Bio Source) diluted at 5000 folds is added and incubatedat room temperature for one hour. After washing, a substrate solution isadded followed by the incubation, and subsequently, the absorbance at405 nm is measured using Microplate Reader Model 3550 (supplied fromBio-Rad) to calculate the concentration of the target antibody.

Modified IL-6 used in the invention is substances having bindingactivity to IL-6 receptor and which do not transmit the biologicalactivity of IL-6. That is, since the modified IL-6 does not transmit thebiological activity of IL-6 although it binds to IL-6 receptorcompetitively with IL-6, it blocks signal transduction by IL-6.

The modified IL-6 is made by introducing variants by substituting aminoacid residues in the amino acid sequence of IL-6. IL-6 which is a sourceof the modified IL-6 can be obtained from any origin, but it ispreferably human IL-6 in consideration of its antigenicity.

Specifically, the modification of IL-6 is carried out by forecasting itssecondary structure of IL-6 amino acid sequence using the molecularmodeling program known in the art, e.g., WHATIF (Vriend et al., Mol.Graphics, 8:52-56, 1990) and further by evaluating effects of amino acidresidues to be substituted on the whole protein. After determiningsuitable amino acid residues to be substituted, the gene encoding themodified IL-6 is obtained by introducing the variants by theconventional PCR method such that the amino acids are substituted usingthe vector containing the base sequence encoding human IL-6 gene as thetemplate. The modified IL-6 can be obtained by incorporating this intothe appropriate vector as needed and following to the above methods forthe expression, production and purification of the recombinant antibody.

Specific examples of the modified IL-6 are disclosed in Brakenhoff etal., J. Biol. Chem., 269:86-93, 1994 and Savino et al., EMBO J.,13:1357-1367, 1994, WO 96/18648 and WO 96/17869.

Partial peptides of IL-6 or partial peptides of IL-6 receptor used inthe invention have binding activity to IL-6 receptor or IL-6,respectively, and are substances which do not transmit the biologicalactivity of IL-6. That is, the partial peptide of IL-6 or the partialpeptide of IL-6 receptor specifically inhibits the binding of IL-6 toIL-6 receptor by binding to and capturing IL-6 receptor or IL-6,respectively. Consequently, since they do not transmit the biologicalactivity of IL-6, they block the signal transduction by IL-6.

The partial peptide of IL-6 or the partial peptide of IL-6 receptor isthe peptide composed of partial or entire amino acid sequence involvedin the binding of IL-6 to IL-6 receptor in the amino acid sequence ofIL-6 or IL-6 receptor. Such a peptide is composed of typically from 10to 80, preferably from 20 to 50, and more preferably from 20 to 40 aminoacid residues. The partial peptide of IL-6 or the partial peptide ofIL-6 receptor can be made by defining the region involved in the bindingto IL-6 or IL-6 receptor in the amino acid sequence of IL-6 or IL-6receptor and synthesizing its partial or entire amino acid sequence bythe methods commonly known, e.g., gene engineering technique or peptidesynthesis methods.

In order to make the partial peptide of IL-6 or the partial peptide ofIL-6 receptor by the gene engineering technique, it can be obtained byinserting the DNA sequence encoding the desired peptide into theexpression vector and following to the above expression, production andpurification methods of the recombinant antibody.

In order to prepare the partial peptide of IL-6 or the partial peptideof IL-6 receptor by the peptide synthesis method, it is possible to usethe methods typically used in peptide synthesis, for example, the solidphase synthesis method or liquid phase synthesis method.

Specifically, the synthesis can be carried out according to ZokuIyakuhin, Kaihatu Vol. 14 Peptide Gosei, (Ed., Yajima, H., HirokawaShoten, 1991). As the solid phase synthesis method, used is, forexample, the method where the peptide chain is extended by binding anamino acid corresponding to the C terminus of the peptide to besynthesized to a support which is insoluble in an organic solvent, andalternately repeating a reaction in which one amino acid is sequentiallycondensed in the direction from the C to N terminus in amino acids ofwhich α-amino group and side chain functional groups are protected withappropriate protecting groups and a reaction in which the protectinggroup of α-amino group is eliminated in the amino acids or peptideattached on the resin. The solid phase synthesis methods are broadlyclassified into Boc method and Fmoc method depending on the types ofprotecting groups used.

After the target peptide is synthesized in this way, deprotectionreaction and cleavage reaction of the peptide chain from the support arecarried out. In the cleavage reaction of the peptide chain, hydrogenfluoride or trifluoromethane sulfonate and TFA can be typically used inBoc method and Fmoc method, respectively. In Boc method, the aboveprotected peptide resin is treated with hydrogen fluoride in thepresence of anisole. Then, the elimination of the protecting group andthe cleavage from the support are carried out to recover the peptide.This is lyophilized to yield the crude peptide. On the other hand, inFmoc method, for example, in TFA, the deprotection reaction and thecleavage reaction of the peptide chain from the support can be carriedout by the same manipulation as the above.

The resultant crude peptide can be isolated and purified by applying onHPLC. The elution can be performed under an optimal condition using awater-acetonitrile solvent typically used for the purification ofprotein. Fractions corresponding to peaks in a profile of the resultantchromatography are collected and lyophilized. The peptide fractionspurified in this way are identified by analysis of molecular weights bymass spectrometry, amino acid composition analysis or amino acidsequence analysis.

The specific examples of the partial peptides of IL-6 and IL-6 receptorare disclosed in JP-A-2-188600, 7-324097, and 8-311098, and U.S. Pat.No. 5,210,075.

The pharmaceutical compositions of the invention may be those containingpharmaceutically acceptable carriers and additives depending on theiradministration pathways. Examples of such carriers and additives includewater, pharmaceutically acceptable organic solvents, collagen, polyvinylalcohol, polyvinylpyrrolidone, carboxyvinyl polymer, sodiumcarboxymethylcellulose, sodium polyacrylate, sodium arginate,water-soluble dextran, sodium carboxymethyl starch, pectin, methylcellulose, ethyl cellulose, xanthane gum, gum arabic, casein, gelatin,agarose, diglycerin, propyleneglycol, polyethylene glycol, petrolatum,paraffin, stearyl alcohol, stearic acid, human serum albumin (HSA),mannitol, sorbitol, lactose, acceptable surfactants as pharmaceuticaladditives and the like. The additives used are selected appropriatelyfrom the above or in combination depending on their formulation, but arenot limited thereto.

EXAMPLES

The present invention is specifically described below by examples andreference examples, but the invention is not limited thereto.

Example 1

MRA is a recombinant humanised anti-human interleukin-6 receptormonoclonal antibody of the IgGl sub-class that inhibits the function ofthe cytokine interleukin-6 (IL-6). In early studies in Japan and Europe,MRA showed promise in the treatment of rheumatoid arthritis and wastolerated well.

This was a large, Phase II trial of MRA to determine the optimum dose ofMRA given alone and in combination with methotrexate for the treatmentof rheumatoid arthritis. The potential efficacy of repeated intravenousdoses of MRA, both as monotherapy and in combination with methotrexate,were assessed in patients with active rheumatoid arthritis despite ofthe treatment with methotrexate for a specified period of time andcompared to methotrexate monotherapy. The efficacy, safety andtolerability of MRA were assessed.

Methods:

Subjects: Patients with rheumatoid arthritis diagnosed based on the 1987disease classification of the American College of Rheumatology (ACR), ofat least 6 months duration were enrolled. Patient must have activedisease and had an inadequate response to, or disease flare on MTX givenfor at least 6 months at a dose of at least 12.5 mg weekly or 10 mgweekly in the case of intolerance.

Study design: a double-blind, randomized, parallel group study bycentral randomization method Dosage and Administration: Seven groups: 0mg/kg (placebo)+MTX, 2 mg/kg MRA+MTX, 4 mg/kg MRA+MTX, 8 mg/kg MRA+MTX,2 mg/kg MRA+MTX placebo, 4 mg/kg MRA+MTX placebo, and 8 mg/kg MRA+MTXplacebo. MRA or placebo administration is given by intravenous infusion,at 4-week intervals. MTX or MTX placebo administration is given orally,once weekly, at 10-25 mg/week.

Study Method: The assigned dose was administered by intravenousinfusion, four times in total at 4-week intervals, and efficacy andsafety were evaluated at 2-week intervals up to 16 weeks, and follow-upobservation was done at 20 weeks. The primary endpoint for efficacy wasthe rate of ACR 20 at 16 weeks (4 weeks after the last dose). Secondaryendpoints included rates of ACR 50 and ACR 70 at 16 weeks (4 weeks afterthe last dose).

ACR improvement criteria: The cases where among the following 7 items,the number of swelling joints and the number of pain joints are improvedby 20% or more and improvement by 20% or more is observed in three outof the remaining five items are determined as 20% or more improvement inACR criteria. Further, 50% and 70% improvement cases indicate thepatient cases where the above 20% improved parts are improved by 50% and70%, respectively.

(1) Number of swelling joints

(2) Number of tender joints

(3) Pain assessment by a patient

(4) Global assessment of disease activity by a patient

(5) Global disease activity by a physician

(6) Assessment of physical function by a patient

(7) CRP or ESR TABLE 1 2 mg/kg MRA 4 mg/kg MRA 8 mg/kg MRA MTX ACR 2030.8% 61.1% 62.7% 40.8% ACR 50 5.8% 27.8% 41.2% 28.6% ACR 70 1.9% 5.6%15.7% 16.3% 2 mg/kg 4 mg/kg 8 mg/kg MRA + MTX MRA + MTX MRA + MTX ACR 2064.0% 63.3% 73.5% ACR 50 32.0% 36.7% 53.1% ACR 70 14.0% 12.2% 36.7%

Statistically significantly higher ACR 20 improvement rate was observedin all groups except the MRA alone 2 mg/kg group compared to the controlgroup. In the MRA 8 mg/kg+MTX group, ACR 50 and 70 improvement rate were53.1% and 36.7%, respectively, which were statistically significantlyhigher than those of the control group which were 28.6% and 16.3%,respectively. In the MRA alone groups, statistically significant dosedependency was observed in ACR 20 improvement rate. Also, for ACR50 andACR70 improvement rate, the statistically significant dose dependentresponse was observed in both MRA alone and MTX-combined groups.

Reduction of Swollen Joint Count (Table 2)

The mean swollen joint count was similar across all the treatment groupsat baseline.

There was a cumulative reduction in the mean swollen joint count frombaseline with increasing duration of exposure in all seven treatmentgroups. The mean reduction in the swollen joint count in the MRA 8 mg/kggroup was statistically significant compared with the reduction in theMTX group (p=0.010). At Week 16, the mean difference (95% CI) betweenthe MRA 8 mg/kg group and the MTX group was −2.31 (−4.07, −0.55). Therewas a statistically significant linear dose-relationship between the MRAmonotherapy groups (p<0.001). The mean reduction in swollen joint countin the MRA 8 mg/kg+MTX group was statistically significant compared withthe reduction in the MTX group (p<0.001). The mean difference (95% CI)between the MRA 8 mg/kg+MTX group and the MTX group was −3.62 (−5.39,−1.84). There was a statistically significant linear dose-relationshipbetween the MRA combination therapy groups (p=0.004). TABLE 2 2 mg/kg 4mg/kg 8 mg/kg MRA MRA MRA MTX Baseline: N 52 54 51 49 Mean ± SD 11.6 ±4.6 11.1 ± 4.4 12.2 ± 5.2 12.7 ± 4.2 Change from Baseline: Week 16 N 4243 43 39 Mean ± SD −4.5 ± 5.7 −5.8 ± 4.1 −8.4 ± 4.6 −5.7 ± 6.1 2 mg/kg 4mg/kg 8 mg/kg MRA + MTX MRA + MTX MRA + MTX Baseline: N 50 49 49 Mean ±SD 11.9 ± 4.3 11.9 ± 3.9 11.8 ± 3.9 Change from Baseline: Week 16 N 4642 44 Mean ± SD −6.2 ± 4.6 −6.8 ± 5.4 −9.4 ± 4.0

Among 359 enrolled patients, the safety evaluation sets, the fullanalysis sets, and PPS (per protocol set) were 359, 354, and 307,respectively. Total 359 patients were enrolled, 299 completed the study,and the 60 were withdrawn. Among the withdrawn patients, 33 were due toadverse events, one was due to complication with the other disease,seven were due to adverse events, 7 were due to the use of drugs withprohibited concomitant use, five were due to withdrawal of informedconsent, one was due to lost to follow up, and 22 were due to lack ofefficacy (including multiple reasons).

Among serious adverse events of which causal relationship could not bedenied, five cases of infection were reported. That is, one patient withfoot abscess and osteomyelitis in the 2 mg/kg MRA group, one patientwith chest infection and pleurisy, one patient with septicaemia in the 8mg/kg MRA+MTX group, one patient with septicaemia in the 8 mg/kg MRA+MTXgroup, and one patient with joint infection in the 8 mg/kg MRA+MTXgroup, were reported. In addition to them, five cases ofhypersensitivity were reported as serious adverse events of which causalrelationship could not be denied that is, four patients ofhypersensitivity in the 2 mg/kg MRA group and one patient ofhypersensitivity in the 4 mg/kg MRA group were reported. All of theseevents of hypersensitivity occurred in no combination with MTX after the3rd or 4th MRA administration.

Concerning the laboratory data values for hepatic functions, althoughthe elevation of ALT and AST levels were observed as a result of MRAuse, such elevations were equivalent to those observed in the otherpatients with rheumatoid arthritis. The increase of the laboratory datarelating to lipids (total cholesterol, HDL cholesterol and triglyceride)was observed in the MRA groups. However, there was no overall change inAtherogenic Index.

Slight transient decrease of neutrophil count occurred in some patients.The clinically significant changes of the parameters for diseaseactivity, i.e., the decreases of CRP and ESR and the elevation ofhemoglobin were observed in a dose dependent manner.

Infusion Reaction

An infusion reaction was defined as an adverse event occurring within 24hours of study drug administration. The number of patients experiencingan infusion reaction in each treatment group suggested a possibleinverse dose-response for MRA.

Anti-MRA Antibody

The development of anti-MRA antibodies was examined. None occurred atthe 8 mg/kg treatment groups (monotherapy or combination with MTX). At 2or 4 mg/kg treatment groups, the number of incidents was less in groupsin combination with MTX than MRA monotherapy groups.

Results

A clear dose-response was observed for MRA monotherapy and for MRAcombined with methotrexate. The effectiveness of MRA to treat patientswith rheumatoid arthritis was confirmed for both MRA monotherapy and forMRA combined with methotrexate. Also, safety of MRA was confirmed inboth MRA monotherapy and for MRA combined with methotrexate.

Reference Example 1 Preparation of Human Soluble IL-6 Receptor

The soluble IL-6 receptor was made by the PCR method using plasmid,pBSF2R.236 containing cDNA encoding IL-6 receptor obtained according toYamasaki et al's method (Yamasaki, K. et al., Science, 241:825-828,1988). The plasmid, pBSF2R.236 was digested with a restriction enzyme,Sph1 to obtain IL-6.receptor cDNA, which was then inserted into mp18(supplied from Amersham). Variants were introduced into the IL-6receptor cDNA in PCR method by in vitro mutagenesis system (suppliedfrom Amersham) using synthetic oligoprimers designed to introduce a stopcodon into the cDNA of IL-6 receptor. This manipulation introduced thestop codon at position 345 of the amino acid to give the cDNA encodingthe soluble IL-6 receptor.

The soluble IL-6 receptor cDNA was ligated to the plasmid pSV (suppliedfrom Pharmacia) to afford the plasmid pSVL344 in order to express thecDNA in CHO cells. The soluble IL-6 receptor cDNA digested withHindIII-SalI was inserted into the plasmid pECEdhfr containing cDNA ofdhfr to give CHO cell expression plasmid pECEdhfr344.

By the calcium phosphate precipitation method (Chen, C. et al., Mol.Cell Biol., 7:2745-2751, 1987), 10 μg of the plasmid pECEdhfr344 wastransfected into dhfr-CHO cell line DXB-11 (Urlaub, G. et al., Proc.Natl. Acad. Sci. USA, 77:4216-4220, 1980). The transfected CHO cellswere cultured for 3 weeks in αMEM selection medium containing 1 mM ofglutamine, 10% of dialyzed FCS, 100 U/ml of penicillin and 100 μg/ml ofstreptomycin without nucleoside.

The selected CHO cells were screened by the limiting dilution method,and a single clone of CHO cells was obtained. This CHO clone wasamplified with methotrexate at the concentration of 20 nM to 200 nM toobtain CHO cell line 5E27 which produces the human soluble IL-6receptor. CHO cell line 5E27 was cultured in Iscove's modified Dulbeccomedium (IMDM, supplied from Gibco) containing 5% FBS. The culturesupernatant was collected, and the concentration of the soluble IL-6receptor in the culture supernatant was measured by ELISA. As a result,it was affirmed that the soluble IL-6 receptor was present in theculture supernatant.

Reference Example 2 Preparation of Anti-Human IL-6 Antibody

BALB/c mouse was immunized with 10 μg of recombinant IL-6 (Hirano, T. etal., Immunol. Lett., 17:41, 1988) along with Freund's complete adjuvant,and the immunization was continued every one week until anti-IL-6antibody was detected in serum. Immunized cells were removed from locallymph nodes and fused with myeloma cell line, P3U1 usingpolyethyleneglycol 1500. Hybridomas were selected according to Oi etal's method (Selective Methods in Cellular Immunology, W. H. Freeman andCo., San Francisco, 351, 1980) using HAT medium, and the hybridomaproducing anti-human IL-6 antibody was established.

IL-6 binding assay was carried out as follows for the hybridomasproducing anti-human IL-6 antibody. That is, a flexible polyvinyl96-well microplate (supplied by Dynatech Laboratories, Inc., Alexandra,Va.) was coated with 100 μl of goat anti-mouse Ig (10 μl/ml; suppliedfrom Cooper Biomedical Inc., Malvern, Pa.) in 0.1 M carbonate-hydrogencarbonate buffer (pH 9.6) at 4° C. overnight. Then, the plate wastreated with 100 μl of PBS containing 1% of bovine serum albumin (BSA)for 2 hours at room temperature.

This was washed with PBS, subsequently 100 μl of the hybridoma culturesupernatant was added to each well, and incubated at 4° C. overnight.The plate was washed, then ¹²⁵I labeled recombinant IL-6 was added toeach well to be at 2000 cpm/0.5 ng/well, the plate was washed, andsubsequently radioactivity in each well was measured by a gamma counter(Beckman Gamma 9000, Beckman Instruments, Fullerton, Calif.).Consequently, 32 out of 216 hybridoma clones were positive in the IL-6binding assay. Among these clones, finally stable MH166.BSF2 wasobtained. The anti-IL-6 antibody MH166 produced by the hybridoma has asubtype of IgG1κ.

Then, neutralization activity of MH166 antibody for the growth ofhybridomas was examined using IL-6 dependent mouse hybridoma cloneMH60.BSF2. MH60.BSF2 cells were dispensed at 1×10⁴/200 μl/well, a samplecontaining MH166 antibody was added thereto followed by being culturedfor 48 hours, and 0.5 μCi/well of ³H thymidine (New England Nuclear,Boston, Mass.) was added. After an additional 6 hours' culture, thecells were placed on glass filter paper, and treated using an automaticharvester (Labo Mash Science Co., Tokyo, Japan). Rabbit anti-IL-6antibody was used as the control.

As a result, MH166 antibody inhibited ³H thymidine uptake of MH60.BSF2cells induced by IL-6 in a dose dependent manner. This demonstrated thatMH166 antibody neutralized the activity of IL-6.

Reference Example 3 Preparation of Anti-Human IL-6 Receptor Antibody

Anti-IL-6 receptor antibody MT18 made by Hirano et al's method (Hirano,Y. et al., J. Immunol., 143:2900-2906, 1989) was bound to Sepharose 4B(supplied from Pharmacia Fine Chemicals; Piscataway, N.J.) activated byCNBr according to the attached formulation to purify IL-6 receptor(Yamasaki, K. et al., Science, 241:825-828, 1988). Human myeloma cellline, U266 cells were solubilized with 1 mM of p-para-aminophenylmethanesulfonylfluoride hydrochloride (supplied from Wako Chemicals) containing1% of digitonin (supplied from Wako Chemicals), 10 mM of ethanolamine(pH 7.8) and 1.5 M of NaCl (digitonin buffer), and mixed with MT18antibody bound to Sepharose 4B beads. Subsequently, the beads werewashed with the digitonin buffer six times, and rendered as partiallypurified IL-6 receptor for immunization.

BALB/c mouse was immunized with the above partially purified IL-6receptor obtained from 3×10⁹ U266 cells every 10 days four times, andsubsequently hybridomas were made by the standard method. Bindingactivity to IL-6 receptor was examined in the hybridoma culturesupernatants from growth positive wells by the following method. U266cells at 5×10⁷ were labeled with ³⁵S-methionine (2.5 mCi), andsolubilized with the above digitonin buffer. The solubilized U266 cellswere mixed with 0.04 ml volume of MT18 antibody bound to Sepharose 4Bbeads, subsequently washed with the digitonin buffer six times, then³⁵S-methionine labeled IL-6 receptor was eluted with 0.25 ml of thedigitonin buffer (pH 3.4), and neutralized with 0.025 ml of 1M Tris (pH7.4).

The hybridoma culture supernatant (0.05 ml) was mixed with 0.01 ml ofProtein G Sepharose (supplied from Pharmacia). After washing, theSepharose was incubated with 0.005 ml of the ³⁵S-methionine labeled IL-6receptor solution prepared above. Immunoprecipitate was analyzed bySDS-PAGE, and the hybridoma culture supernatants which reacted with IL-6receptor were examined. Consequently, a reaction positive hybridomaclone, PM-1 (FERM BP-2998) was established. The antibody produced by thehybridoma, PM-1 has a subtype of IgGκ.

Inhibitory activity of the antibody produced by the hybridoma PM-1 wasexamined for the binding of IL-6 to human IL-6 receptor using the humanmyeloma cell line, U266. The human recombinant IL-6 was prepared from E.coli (Hirano, T. et al., Immunol. Lett., 17:41-45, 1988), and¹²⁵I-labeled (Taga, T. et al., J. Exp. Med., 166:967-981, 1987) byBolton-Hunter reagent (New England Nuclear, Boston, Mass.).

U266 cells at 4×10⁵ were cultured with 70% (v/v) of the hybridoma PM-1culture supernatant and 14000 cpm of ¹²⁵I-labeled IL-6. A sample (70 μl)was layered on 300 μl of FCS in a 400 μl microfuge polyethylene tube,and centrifuged followed by measuring radioactivity on the cells.

Consequently, the antibody produced by the hybridoma PM-1 wasdemonstrated to inhibit the binding of IL-6 to IL-6 receptor.

Reference Example 4 Preparation of Anti-Mouse IL-6 Receptor Antibody

A monoclonal antibody against mouse IL-6 receptor was prepared by themethod described in Saito, T. et al., J. Immunol., 147:168-173, 1991.

CHO cells which produce mouse soluble IL-6 receptor were cultured inIMDM medium containing 10% FCS, and the mouse soluble IL-6 receptor waspurified from the culture supernatant using an affinity column where theanti-mouse IL-6 receptor antibody RS12 (See the above Saito, T. et al.)was fixed onto Affigel 10 gel (supplied from Biorad).

The resultant mouse soluble IL-6 receptor (50 μg) was mixed withFreund's complete adjuvant, which was injected into peritoneal cavity ofa Wistar rat. After two weeks, additional immunization was started withFreund's incomplete adjuvant. On the 45th day, spleen cells of the ratwere removed, and 2×10⁸ cells were fused with 1×10⁷ mouse myeloma P3U1cells by the standard method using 50% of PEG1500(supplied fromBoehringer Mannheim) followed by screening hybridomas in HAT medium.

The hybridoma culture supernatants were added to a plate coated withrabbit anti-rat IgG antibody (supplied from Cappel), and subsequentlythe mouse soluble IL-6 receptor was reacted. Then, the hybridomasproducing the antibody against the mouse soluble IL-6 receptor werescreened by ELISA method using rabbit anti-mouse IL-6 receptor antibodyand alkaline phosphatase labeled sheep anti-rabbit IgG. The hybridomaclone in which the production of the antibody was affirmed was subclonedtwice, and a single hybridoma clone was obtained. This clone was namedMR16-1.

Neutralization activity of the antibody produced by this hybridoma wasexamined for signal transduction of mouse IL-6 by uptake of ³H thymidineusing MH60.BSF2 cells (Matsuda, T. et al., J. Immunol., 18:951-956,1988). MH60.BSF2 cells were prepared to be 1×10⁴ cells/200 μl/well in a96-well plate. To this plate, 10 pg/ml of mouse IL-6 and 12.3 to 1000ng/ml of MR16-1 antibody or RS12 antibody were added, then cultured at37° C. for 44 hours at 5% CO₂, and subsequently 1 μCi/well of ³Hthymidine was added. 4 hours later, the uptake of ³H thymidine wasmeasured. Consequently, MR16-1 antibody suppressed uptake of ³Hthymidine of MH60.BSF2 cells.

Accordingly, the antibody produced by the hybridoma MR16-1 (FERMBP-5875) was demonstrated to inhibit the binding of IL-6 to IL-6receptor.

1. A pharmaceutical composition for the treatment of IL-6 relateddiseases, comprising an interleukin 6 antagonist (IL-6 antagonist) andan immunosuppressant.
 2. A pharmaceutical composition comprisingimmunosuppressants, for effect enhancement on the use of IL-6 antagonistfor the treatment of IL-6 related diseases.
 3. A pharmaceuticalcomposition comprising immunosuppressants, for the reduction orprevention of allergic reactions upon the treatment of IL-6 relateddiseases with an IL-6 antagonist.
 4. A therapeutic agent for theadministration at high doses, comprising an IL-6 antagonist.
 5. Apharmaceutical composition comprising a high dose of IL-6 antagonist,for the reduction or prevention of allergic reactions upon the treatmentof IL-6 related diseases.
 6. The pharmaceutical composition according toclaim 1, wherein said IL-6 antagonist is an anti-interleukin-6 receptorantibody (IL-6R antibody).
 7. The pharmaceutical composition accordingto claim 6, wherein said IL-6R antibody is a monoclonal antibody againstIL-6R.
 8. The pharmaceutical composition according to claim 6, whereinsaid anti-IL-6R antibody is a monoclonal antibody against human IL-6R.9. The pharmaceutical composition according to claim 6, wherein saidanti-IL-6R antibody is a monoclonal antibody against mouse IL-6R. 10.The pharmaceutical composition according to claim 6, wherein saidanti-IL-6R antibody is a recombinant antibody.
 11. The pharmaceuticalcomposition according to claim 8, wherein said human anti-IL-6Rmonoclonal antibody is PM-1 antibody.
 12. The pharmaceutical compositionaccording to claim 9, wherein said mouse IL-6R monoclonal antibody isMR16-1 antibody.
 13. The pharmaceutical composition according to claim6, wherein said anti-IL-6R antibody is a chimera antibody, a humanizedantibody or a human type antibody against IL-6R.
 14. The pharmaceuticalcomposition according to claim 13, wherein said humanized antibodyagainst IL-6R is humanized PM-1 antibody.
 15. The pharmaceuticalcomposition according to claim 1, wherein said IL-6 related diseases arerheumatoid arthritis, plasmacytosis, hyperimmunoglobulinemia, anemia,nephritis, cachexia, multiple myeloma, Castleman's disease, mesangialproliferative nephritis, systemic lupus erythematosus, Crohn's disease,ulcerative colitis, pancreatitis, psoriasis, juvenile idiopathicarthritis or systematic juvenile idiopathic arthritis, vasculitis andKawasaki disease.
 16. The pharmaceutical composition according to claim6, which is said pharmaceutical composition comprising theimmunosuppressant or said pharmaceutical composition comprising theantibody and the immunosuppressant, wherein a dosage of anti-IL-6Rantibody is from 0.02 to 150 mg/kg/4 weeks or the dosage showing ananti-IL-6R antibody concentration in blood equivalent thereto.
 17. Thepharmaceutical composition according to claim 16, wherein the dosage ofanti-IL-6R antibody is from 0.5 to 30 mg/kg/4 weeks or the dosageshowing an anti-IL-6R antibody concentration in blood equivalentthereto.
 18. The pharmaceutical composition according to claim 17,wherein the dosage of anti-IL-6R antibody is from 2 to 8 mg/kg/4 weeksor the dosage showing an anti-IL-6R antibody concentration in bloodequivalent thereto.
 19. The pharmaceutical composition according toclaim 4, which is said therapeutic agent for the treatment of IL-6related diseases for the administration at high doses, comprising theanti-IL-6R antibody or said pharmaceutical composition comprising highdoses of the anti-IL-6R antibody, wherein the dosage of anti-IL-6Rantibody is 4 mg/kg/4 weeks or more or the dosage showing an anti-IL-6Rantibody concentration in blood equivalent thereto.
 20. Thepharmaceutical composition according to claim 19, wherein the dosage ofanti-IL-6R antibody is from 6 to 16 mg/kg/4 weeks or the dosage showingan anti-IL-6R antibody concentration in blood equivalent thereto. 21.The pharmaceutical composition according to claim 20, wherein the dosageof anti-IL-6R antibody is from 6 to 10 mg/kg/4 weeks or the dosageshowing an anti-IL-6R antibody concentration in blood equivalentthereto.
 22. The pharmaceutical composition according to claim 1,wherein said immunosuppressant is methotrexate (MTX).
 23. Thepharmaceutical composition according to claim 22, wherein the dosage ofsaid MTX is from 1 to 100 mg/body/week.
 24. The pharmaceuticalcomposition according to claim 23, wherein the dosage of said MTX isfrom 4 to 50 mg/body/week.
 25. The pharmaceutical composition accordingto claim 24, wherein the dosage of said MTX is from 7.5 to 25mg/body/week.
 26. The pharmaceutical composition according to claim 1,for simultaneously administering said anti-IL-6 antibody and saidimmunosuppressant.
 27. The pharmaceutical composition according to claim1, for administering said anti-IL-6 antibody and said immunosuppressantwith time interval.
 28. A use of an interleukin-6 antagonist (IL-6antagonist) and an immunosuppressant for the production of apharmaceutical composition for the treatment of IL-6 related diseases.29. A use of an IL-6 antagonist for the production of a pharmaceuticalcomposition comprising immunosuppressants, for the effect enhancement onthe use of the IL-6 antagonist for the treatment of IL-6 relateddiseases.
 30. A use of an IL-6 antagonist for the production of apharmaceutical composition comprising immunosuppressants, for thereduction or prevention of allergic reactions upon the treatment of IL-6related diseases with the IL-6 antagonist.
 31. A use of an IL-6antagonist for the production of a therapeutic agent of IL-6 relateddiseases for the administration at high doses, comprising the IL-6antagonist.
 32. A use of an IL-6 antagonist for the production of apharmaceutical composition comprising anti-IL-6R antibody at high dosesfor reduction or prevention of allergic reactions upon the treatment ofIL-6 related diseases.
 33. The use according to claim 28, wherein saidIL-6 antagonist is an anti-interleukin-6 receptor antibody (IL-6Rantibody).
 34. The use according to claim 28, wherein said IL-6Rantibody is a monoclonal antibody against IL-6R.
 35. The use accordingto claim 28, wherein said anti-IL-6R antibody is a monoclonal antibodyagainst human IL-6R.
 36. The use according to claim 28, wherein saidanti-IL-6R antibody is a monoclonal antibody against mouse IL-6R. 37.The use according to claim 28, wherein said anti-IL-6R antibody is arecombinant antibody.
 38. The use according to claim 35, wherein saidhuman anti-IL-6R monoclonal antibody is PM-1 antibody.
 39. The useaccording to claim 36, wherein said mouse anti-IL-6R monoclonal antibodyis MR16-1 antibody.
 40. The use according to claim 32, wherein saidanti-IL-6R antibody is a chimera antibody, a humanized antibody or ahuman type antibody against IL-6R.
 41. The use according to claim 40,wherein said humanized antibody against IL-6R is humanized PM-1antibody.
 42. The use according to claim 21, wherein said IL-6 relateddiseases are rheumatoid arthritis, plasmacytosis,hyperimmunoglobulinemia, anemia, nephritis, cachexia, multiple myeloma,Castleman's disease, mesangial proliferative nephritis, systemic lupuserythematosus, Crohn's disease, pancreatitis, psoriasis, juvenileidiopathic arthritis or systematic juvenile idiopathic arthritis. 43.The use according to claim 33, which is said use for the production ofthe pharmaceutical composition comprising the immunosuppressant or thepharmaceutical composition comprising anti-IL-6 antibody and theimmunosuppressant, wherein a dosage of anti-IL-6R antibody is from 0.02to 150 mg/kg/4 weeks or the dosage showing an anti-IL-6R antibodyconcentration in blood equivalent thereto.
 44. The use according toclaim 43, wherein the dosage of anti-IL-6R antibody is from 0.5 to 30mg/kg/4 weeks or the dosage showing an anti-IL-6R antibody concentrationin blood equivalent thereto.
 45. The use according to claim 44, whereinthe dosage of anti-IL-6R antibody is from 2 to 8 mg/kg/4 weeks or thedosage showing an anti-IL-6R antibody concentration in blood equivalentthereto.
 46. The use according to claim 31, which is said use for theproduction of therapeutic agent for the treatment of IL-6 relateddiseases for the administration at high dose, comprising the anti-IL-6Rantibody or said pharmaceutical composition comprising high doses of theanti-IL-6R antibody, wherein the dosage of anti-IL-6R antibody is 4mg/kg/4 weeks or more or the dosage showing an anti-IL-6R antibodyconcentration in blood equivalent thereto.
 47. The use according toclaim 46, wherein the dosage of anti-IL-6R antibody is from 6 to 16mg/kg/4 weeks or the dosage showing an anti-IL-6R antibody concentrationin blood equivalent thereto.
 48. The use according to claim 47, whereinthe dosage of anti-IL-6R antibody is from 6 to 10 mg/kg/4 weeks or thedosage showing an anti-IL-6R antibody concentration in blood equivalentthereto.
 49. The use according to claim 28, wherein saidimmunosuppressant is methotrexate (MTX).
 50. The pharmaceuticalcomposition according to claim 49, wherein the dosage of said MTX isfrom 1 to 100 mg/body/week.
 51. The pharmaceutical composition accordingto claim 50, wherein the dosage of said MTX is from 4 to 50mg/body/week.
 52. The pharmaceutical composition according to claim 5 1,wherein the dosage of said MTX is from 7.5 to 25 mg/body/week.
 53. Theuse according to claim 28, for simultaneously administering saidanti-IL-6 antibody and said immunosuppressant.
 54. The use according toclaim 28, for administering said anti-IL-6 antibody and saidimmunosuppressant with time interval.
 55. A method comprisingadministering an IL-6 antagonist and an immunosuppressant to a patientrequiring such a treatment in the method for the treatment of IL-6related diseases.
 56. A method for the effect enhancement on the use ofan IL-6 antagonist for the treatment of IL-6 related diseases,comprising administering immunosuppressants and an IL-6 antagonist to apatient requiring such a treatment.
 57. A method for the reduction orprevention of allergic reactions upon the treatment of IL-6 relateddiseases with an IL-6 antagonist, comprising administeringimmunosuppressants and an IL-6 antagonist to a patient requiring such atreatment.
 58. A method comprising administering an IL-6 antagonistanti-IL-6R antibody at a high dose to a patient requiring such atreatment in the method for the treatment of IL-6 related diseases witha high dose administration of an IL-6-antagonist.
 59. A method for thereduction or prevention of allergic reaction upon the treatment of IL-6related diseases, comprising administering a high dose administration ofan IL-6 antagonist to a patient requiring such a treatment.
 60. Themethod according to claim 55, wherein said IL-6 antagonist is ananti-IL-6R antibody.
 61. The method according to claim 55, wherein saidanti-IL-6R antibody is a monoclonal antibody against human IL-6R. 62.The method according to claim 55, wherein said anti-IL-6R antibody is amonoclonal antibody against mouse IL-6R.
 63. The method according toclaim 55, wherein said anti-IL-6R antibody is a recombinant antibody.64. The method according to claim 61, wherein said human anti-IL-6Rmonoclonal antibody is PM-1 antibody.
 65. The method according to claim62, wherein said mouse anti-IL-6R monoclonal antibody is MR16-1antibody.
 66. The method according to claim 59, wherein said anti-IL-6Rantibody is a chimera antibody, a humanized antibody or a human typeantibody against IL-6R.
 67. The method according to claim 66, whereinsaid humanized antibody against IL-6R is humanized PM-1 antibody. 68.The method according to claim 55, wherein said IL-6 related diseases arerheumatoid arthritis, plasmacytosis, hyperimmunoglobulinemia, anemia,nephritis, cachexia, multiple myeloma, Castleman's disease, mesangialproliferative nephritis, systemic lupus erythematosus, Crohn's disease,pancreatitis, psoriasis, juvenile idiopathic arthritis, or systematicjuvenile idiopathic arthritis.
 69. The method according to claim 60,which is said method for the treatment wherein the immunosuppressant, oranti-IL-6R antibody and the immunosuppressant are administered, whereina dosage of anti-IL-6R antibody is from 0.02 to 150 mg/kg/4 weeks or thedosage showing an anti-IL-6R antibody concentration in blood equivalentthereto.
 70. The method according to claim 69, wherein the dosage ofanti-IL-6R antibody is from 0.5 to 30 mg/kg/4 weeks or the dosageshowing an anti-IL-6R antibody concentration in blood equivalentthereto.
 71. The method according to claim 70, wherein the dosage ofanti-IL-6R antibody is from 2 to 8 mg/kg/4 weeks or the dosage showingan anti-IL-6R antibody concentration in blood equivalent thereto. 72.The method according to claim 58, which is said method for the treatmentof IL-6 related diseases or said method for the treatment wherein a highdose of anti-IL-6R antibody is administered comprising administering thehigh dose of anti-IL-6R antibody, wherein the dosage of anti-IL-6Rantibody is 4 mg/kg/4 weeks or more or the dosage showing an anti-IL-6Rantibody concentration in blood equivalent thereto.
 73. The methodaccording to claim 72, wherein the dosage of anti-IL-6R antibody is from6 to 16 mg/kg/4 weeks or the dosage showing an anti-IL-6R antibodyconcentration in blood equivalent thereto.
 74. The method according toclaim 73, wherein the dosage of anti-IL-6R antibody is from 6 to 10mg/kg/4 weeks or the dosage showing an anti-IL-6R antibody concentrationin blood equivalent thereto.
 75. The method according to claim 55 any,wherein said immunosuppressant is methotrexate (MTX).
 76. The methodaccording to claim 75, wherein the dosage of said MTX is from 1 to 100mg/body/week.
 77. The method according to claim 76, wherein the dosageof said MTX is from 4 to 50 mg/body/week.
 78. The method according toclaim 77, wherein the dosage of said MTX is from 7.5 to 25 mg/body/week.79. The method according to claim 55, for simultaneously administeringsaid anti-IL-6R antibody and said immunosuppressant.
 80. The useaccording to claim 55, for administering said anti-L-6R antibody andsaid immunosuppressant with time interval.